# AMERICAN DRUG STORES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OSCO DRUG \#4228
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023064797
- **Authorized official:** TIFFANY ELIOPULOS (ENROLLMENT ASSISTANT MANAGER)
- **Authorized official phone:** (208) 395-3906

## Contact information

- **Practice address:** 2128 S MANNHEIM RD, WESTCHESTER, IL 60154
- **Practice address phone:** (708) 562-7334
- **Practice address fax:** (708) 562-9945
- **Mailing address:** 250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
- **Mailing address phone:** (208) 395-6200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054-008133 | IL | Yes |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 06/28/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2018156 | PK | — |